ICD-10 Coding for High PSA(R97.20, R97.21)
Complete ICD-10-CM coding and documentation guide for High PSA. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to High PSA
R97.2-R97.21Primary Range
Abnormal tumor markers
This range includes codes for elevated PSA, which is a key marker in prostate health assessment.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R97.20 | Elevated prostate specific antigen [PSA] | Use for initial elevated PSA findings without a history of prostate cancer. |
|
| R97.21 | Rising PSA following treatment for malignant neoplasm of prostate | Use for patients with a history of prostate cancer and rising PSA levels post-treatment. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for elevated PSA
Essential facts and insights about High PSA
Primary ICD-10-CM Codes for high psa
Decision Criteria
clinical Criteria
- PSA level above normal range without cancer history
documentation Criteria
- Document specific PSA value and clinical context
Applicable To
- Initial elevated PSA without known cancer
Excludes
- Rising PSA post-treatment (R97.21)
Clinical Validation Requirements
- PSA value > 4 ng/mL
- Absence of prostate cancer diagnosis
Code-Specific Risks
- Incorrect use without documented PSA value
- Confusion with screening codes
Coding Notes
- Ensure PSA levels and clinical context are documented.
R97.21 - Rising PSA following treatment for malignant neoplasm of prostate
Use for patients with a history of prostate cancer and rising PSA levels post-treatment.
Applicable To
- Rising PSA post-prostate cancer treatment
Excludes
- Initial elevated PSA without treatment history (R97.20)
Clinical Validation Requirements
- History of prostate cancer
- Documented rise in PSA post-treatment
Coding Notes
Ensure documentation of cancer history and treatment details.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting High PSA to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R97.20.
Impact
Clinical: May lead to inappropriate follow-up care., Regulatory: Potential for audit issues., Financial: Claims may be denied or delayed.
Mitigation Strategy
Clearly document the purpose of the PSA test., Use appropriate ICD-10 and CPT codes.
Impact
Reimbursement: Claims may be denied due to lack of supporting documentation., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data reporting and analysis.
Mitigation Strategy
Ensure PSA levels are documented in the medical record.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Potential audit risks., Data Quality: Misclassification of patient data.
Mitigation Strategy
Use Z12.5 for screening and R97.20 for diagnostic purposes.
Impact
Lack of specific PSA values and clinical context in documentation.
Mitigation Strategy
Ensure all PSA results and clinical indications are documented.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for High PSA, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for High PSA
Use these documentation templates to ensure complete and accurate documentation for High PSA. These templates include all required elements for proper coding and billing.
Initial Elevated PSA
Specialty: UrologyRequired Elements
- Chief complaint
- PSA level
- Clinical context
- Differential diagnosis
- Plan for follow-up
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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